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Journal of the American College of... Jan 2020
Topics: Coronary Artery Bypass; Coronary Vessels; Humans; Mammary Arteries; Surgeons
PubMed: 31976864
DOI: 10.1016/j.jacc.2019.12.005 -
Brazilian Journal of Cardiovascular... Sep 2022Although the saphenous vein is a widely used conduit for coronary artery bypass grafting, revascularization using the saphenous vein as an aortocoronary bypass graft has... (Review)
Review
Although the saphenous vein is a widely used conduit for coronary artery bypass grafting, revascularization using the saphenous vein as an aortocoronary bypass graft has shown disadvantages of lower long-term graft patency rates and subsequently worse clinical outcomes, compared with revascularization using the internal thoracic artery. Of the various efforts to overcome the limitations of vein conduit that are resulting from structural and functional differences from arterial conduit, recent technical improvement in no-touch vein composite graft construction and outcomes of revascularization using no-touch vein composite grafts based on the left internal thoracic artery will be discussed in this topic.
Topics: Coronary Artery Bypass; Humans; Mammary Arteries; Saphenous Vein; Treatment Outcome; Vascular Patency
PubMed: 36054000
DOI: 10.21470/1678-9741-2022-0119 -
The Journal of Thoracic and... Apr 2022We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal...
OBJECTIVES
We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts.
METHODS
From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or RITA (RITA group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the RITA group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months.
RESULTS
The early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and RITA groups, 10.3% and 8.4%, respectively; P = .639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and RITA groups (14.1% and 10.2%, respectively; P = .487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P = .470), cardiac mortality-free survival (92.1% vs 90.9%; P = .560), freedom from target vessel revascularization (83.0% vs 91.4%; P = .230), freedom from reintervention (68.8% vs 76.2%; P = .731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P = .364) rates between the matched groups.
CONCLUSIONS
Total arterial revascularization using RGEA composite grafts showed comparable results to those using RITA composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.
Topics: Aged; Coronary Artery Disease; Female; Follow-Up Studies; Gastroepiploic Artery; Graft Occlusion, Vascular; Humans; Male; Matched-Pair Analysis; Middle Aged; Myocardial Revascularization; Retrospective Studies; Thoracic Arteries; Vascular Patency
PubMed: 32739170
DOI: 10.1016/j.jtcvs.2020.05.096 -
International Journal of Surgery... Feb 2021There is still lack of convincing evidence about the superiority of bilateral internal thoracic artery (BITA) use in coronary artery bypass grafting (CABG) and BITA... (Review)
Review
There is still lack of convincing evidence about the superiority of bilateral internal thoracic artery (BITA) use in coronary artery bypass grafting (CABG) and BITA grafts continue to be underutilized. Arterial Revascularization Trial (ART) did not demonstrate the superiority of BITA versus single ITA grafting after 10 years. We have reviewed the most recent literature, assessed the current status as well as indications of BITA grafting in the post-ART era. We believe that BITA grafting is not appropriate for all patients especially in light of the findings of ART. However, the use of BITA is justified in patients of younger age and those without comorbidities (poorly controlled diabetes, obesity, chronic obstructive pulmonary disease, previous mediastinal irradiation, long-term steroid use, elderly women). Further prospective randomized studies with long-term follow-up are needed to validate the benefits of BITA grafting.
Topics: Aged; Contraindications, Procedure; Coronary Artery Bypass; Coronary Artery Disease; Female; Humans; Male; Mammary Arteries; Middle Aged; Treatment Outcome
PubMed: 33388437
DOI: 10.1016/j.ijsu.2020.12.007 -
Comparative analysis of the hydrogen sulphide pathway in internal thoracic artery and radial artery.Interactive Cardiovascular and Thoracic... Jul 2022The molecular basis supporting the superiority of the left internal thoracic artery (LITA) as a bypass conduit is limited. This study was conducted to compare the... (Comparative Study)
Comparative Study
OBJECTIVES
The molecular basis supporting the superiority of the left internal thoracic artery (LITA) as a bypass conduit is limited. This study was conducted to compare the expression and localization of hydrogen sulphide synthesizing enzymes in LITA and radial artery (RA).
METHODS
Nineteen patients who underwent coronary artery bypass grafting using LITA and RA were enrolled. The remnant LITA and RA were collected to measure the expression levels of 3 hydrogen sulphide-producing enzymes: cystathionine β-synthase, cystathionine γ-lyase and 3-mercaptopyruvate sulphurtransferase using quantitative real-time polymerase chain reaction. Expression levels of these enzymes in the LITA and RA were compared in each subject. The expression and localization patterns of the enzymes were also analysed by immunohistochemistry.
RESULTS
The mRNA expression of the cystathionine β-synthase was greater in the LITA than in the RA (P = 0.033), whereas the expression levels of the other 2 enzymes did not significantly differ between the 2 arteries. The immunohistochemistry analysis demonstrated greater expression of the cystathionine β-synthase in the LITA than in the RA (P = 0.006). This protein was present in both tunica intima and tunica media of the LITA, although it was present only in the tunica media of the RA. Localization patterns of the other 2 enzymes were not different between LITA and RA.
CONCLUSIONS
Expression levels of the mRNA and protein of cystathionine β-synthase were significantly greater in LITA than in the RA. These findings might be a factor that affects the superior patency rate of LITA.
Topics: Cystathionine beta-Synthase; Humans; Hydrogen Sulfide; Mammary Arteries; RNA, Messenger; Radial Artery; Treatment Outcome
PubMed: 35426918
DOI: 10.1093/icvts/ivac105 -
The Journal of Thoracic and... Apr 2015
Topics: Coronary Artery Bypass; Female; Humans; Male; Mammary Arteries
PubMed: 25636527
DOI: 10.1016/j.jtcvs.2014.12.046 -
The Journal of Thoracic and... Apr 2022
Topics: Coronary Artery Bypass, Off-Pump; Gastroepiploic Artery; Internal Mammary-Coronary Artery Anastomosis; Mammary Arteries
PubMed: 32713645
DOI: 10.1016/j.jtcvs.2020.06.039 -
Journal of the American College of... Jan 2020The importance of a coronary artery, based on the myocardial mass it perfuses, is well documented, but little is known about the importance of a vessel that has been... (Observational Study)
Observational Study
BACKGROUND
The importance of a coronary artery, based on the myocardial mass it perfuses, is well documented, but little is known about the importance of a vessel that has been bypassed and its effect on survival in the context of bilateral internal thoracic artery (BITA) grafting.
OBJECTIVES
This study determined the effect of a dominant left anterior descending (LAD) artery and important non-LAD targets on outcomes after BITA grafting.
METHODS
From January 1972 to January 2011, of 6,127 patients who underwent BITA grafting, 2,551 received 1 ITA grafted to the LAD and had an evaluable coronary angiogram. A dominant LAD was defined as one that was wrapped around the left ventricular apex. Non-LAD targets were graded based on their terminal reach toward the apex: important: >75% (n = 1,698); and less important: ≤75% (n = 853). Mean follow-up was 14 ± 8.7 years. Multivariable analysis was performed to identify risk factors for time-related mortality.
RESULTS
A dominant LAD was present more frequently in patients with less important additional targets (51% vs. 35%; p < 0.0001). A total of 179 patients (7.0%) received a second ITA to multiple targets, 77 (43%) of which were to multiple important target vessels. Unadjusted late survival was similar regardless of degree of importance of the second ITA target-77% at 15 years (p = 0.70) for the important and less important targets, respectively. In the multivariable model, grafting the second ITA to multiple important targets was associated with better long-term survival (p = 0.005). In patients with a nondominant LAD, a second ITA grafted to a less important artery was associated with higher risk of operative mortality (2.4% vs. 0.51%; p = 0.007). A saphenous vein graft to an important or less important target did not influence long-term survival.
CONCLUSIONS
In BITA grafting, bypassing multiple important targets to maximize myocardium supplied by ITAs improved long-term survival. In patients with a nondominant LAD, selecting an important target for the second ITA lowered operative mortality.
Topics: Coronary Artery Bypass; Coronary Vessels; Female; Follow-Up Studies; Hospital Mortality; Humans; Male; Mammary Arteries; Middle Aged; Prospective Studies; Survival Rate
PubMed: 31976863
DOI: 10.1016/j.jacc.2019.11.026 -
Brazilian Journal of Cardiovascular... Aug 2020To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary... (Review)
Review
OBJECTIVE
To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies.
METHODS
We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review.
RESULTS
The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries.
CONCLUSION
The internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children.
Topics: Child; Child, Preschool; Coronary Artery Bypass; Coronary Vessels; Humans; Infant; Mammary Arteries; Mucocutaneous Lymph Node Syndrome; Retrospective Studies; Transposition of Great Vessels
PubMed: 32864935
DOI: 10.21470/1678-9741-2019-0366 -
Annals of the Royal College of Surgeons... Sep 2022Collateralisation around stenotic or occlusive arterial disease is a commonly observed adaptation for maintenance of arterial perfusion. It occurs through pathways of...
Collateralisation around stenotic or occlusive arterial disease is a commonly observed adaptation for maintenance of arterial perfusion. It occurs through pathways of well-understood embryological origin. Examples include Winslow's pathway (internal thoracic artery to iliac artery via the epigastric arteries) and the arc of Riolan (between superior and inferior mesenteric arteries). In this article, we describe a pathway of collateralisation around stenotic disease of the coeliac and superior mesenteric arteries in a 76-year-old man with an abdominal aortic aneurysm. The collateral pathway was identified on computed tomography angiography between the left internal thoracic artery in the thorax and the coeliac artery in the abdomen via the left inferior phrenic artery. This has implications for routine cardiac surgery, such that left internal thoracic artery harvest during coronary artery bypass surgery would likely result in acute ischaemia of the abdominal viscera.
Topics: Aged; Celiac Artery; Collateral Circulation; Constriction, Pathologic; Humans; Iliac Artery; Male; Mammary Arteries; Thorax
PubMed: 35446694
DOI: 10.1308/rcsann.2021.0354